Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis and differentiation of bacterial infections in the critically ill patients. Methods A total of 53 critical patients were divided into bacterial infection group and non-bacterial infection group. Serum PCT was measured by immunoluminometric assay. Results PCT of bacterial infection group was significantly higher than that in non-bacterial infection group (?~2=0.05, P

0.05).No significant difference on mortality was found between infection disease and non-infection disease.The mortality of patients with platelet count less than or equal to 50?109/L was higher than those with platelet count greater than 50?109/L(P

OBJECTIVE To study the isolation status and antimicrobial resistance of nonfermenting Gram-negative bacilli collected from intensive care unit(ICU) of our hospital so as to instruct the rational clinical application of antibiotics.METHODS The antimicrobial resistance of nonfermenting Gram-negative bacilli isolates collected from patients in ICU from Jan 2003 to Dec 2007 was analyzed.Antimicrobial susceptibility of clinical isolates were tested by Kirby-Bauer method.RESULTS Total 384 nonfermenting Gram-negative bacilli isolates were collected in 5 years.The most common species were Acinetobacter baumannii(219),Pseudomonas aeruginosa(117) and Stenotrophomonas maltophilla(36).The antimicrobial resistance rate of nonfermenting Gram-negative bacterial to most antibiotics were much higher.The antimicrobial resistance rate of Acinetobacter spp to imipenem,cefoperazone/sulbactam and piperacillin/tazobactam was 3.7%,28.3% and 42.9%.But the resistance rate of Acinetobacter spp to imipenem was increased in recent 2 years(58.0%).The antimicrobial resistance rate of P.aeruginosa to cefoperazone/sulbactam was the lowest.That of imipenem-resistant P.aeruginosa to cefoperazone/sulbactam was 34.0%.S.maltophilla was relatively susceptible to ceftazidime,cefoperazone/sulbactam and piperacillin/tazobactam.CONCLUSIONS Nonfermenters Gram-negative bacilli are the important pathogens in ICU.Surveillance of their prevalence and drug resistance may provide evidences for rational antibiotic choices.

Objective To investigate the correlation between platelet-related parameters and the severity as well as prognosis of septic patients.Methods A total of 91 patients with sepsis were included in this study, and the platelet-related parameters were detected in all patients within 24 hours and 72 hours after admission to hospital, respectively.Clinical information of each patient was recorded including age, gender and underlying diseases, APACHE Ⅱ score at admission and the incidence of the consequent multiple organ dysfunction syndrome (MODS) and 28-day mortality.The differences in platelet-related parameters between non-severe sepsis group and severe sepsis group were compared, the correlation between plateletrelated parameters and the prognosis was studied by using rank method and the reliability of platelet-related parameters to predict the prognosis was estimated by using receiver operating characteristic curve (ROC).Results The differences in results of platelet-related parameters between non-severe sepsis group and severe sepsis group within 24 hours and 72 hours after admission were as follows : platelet count : (166.34 ± 58.27) ×109L-1vs.(198.57±65.82) ×109L-1, P=0.02and (138.85 ± 53.31) ×109L-1vs.(173.79 ± 67.48) × 109 L-1, P =0.00;the platelet distribution width (PDW) : (13.84 ± 2.46) ％ vs.(12.73±1.72)％, P=0.01 and (16.07 ±2.87)％ vs.(13.86 ±2.31)％, P=0.00;mean platelet volume (MPV) : (10.17 ±1.82) fl (femto-liter) vs.(9.32 ±1.34) fl, P=0.01 and (11.49 ± 1.53)fl vs.(10.37 ± 1.24) fl, P =0.00, respectively.The value of the PDW showed positive correlation with the prognosis (dead) (r=0.51, P＜0.05), and the MPV did likewise (r=0.53, P＜0.05, while the platelet count negatively correlated (r =-0.61, P ＜ 0.05), These characteristics were more obvious at 72 hours after admission (rPDW =0.68, rPv =0.67, rPLT =-0.71, P ＜0.01).The areas under the ROC curve 72 hours after admission as follows: PLT count0.95, PDW0.93 and MPV0.93, respectively, which were higher than those of PLT count (0.88), PDW (0.82) and MPV (0.83) within 24 hours after admission.The sensitivity and specificity of platelet count 72 hours after admission predicting the prognosis of death were 91.24％ and 80.35％, respectively.Conclusions The changes of platelet-related parameters in septic patients are related to the severity of the disease, and platelet count at 72 hours after admission may play an important role in prognosis of disease.

Objective To investigate the occurrence of thyroid disorders in septic patients and the relationship between thyroid hormone level and the change of left ventricular function.Methods A total of 63 septic patients,43 male and 20 female,aged 50 to 88 years with mean 63.3 ± 18.5,were included in the present study.The thyroid hormone levels and C-reactive protein (CRP) levels were detected in all patients on the next day of admission.Clinical information of each patient was recorded including demographics and co-existed disease,APACHE Ⅱ score at admission and the incidence of shock and subsequent multiple organ dysfunction syndrome (MODS).At 24 hours,the second week and the third week after admission,a serial trans-thoracic echocardiography were performed in all patients to observe changes of left ventricular end diastolic dimension,left ventricular eject fraction and E/A (the ratio between maximal velocity of blood flow at mitral valve orifice in the early diastolic phase and maximal velocity of blood flow of atrium in systolic phase).Another 38 patients with ordinary infections,21 male and 17 female,with mean age 58.6 ± 16.8 (48-84 years) were selected as controls for comparison.The difference in thyroid function between sepsis group and control group was analyzed.The levels of serum thyroid hormone associated with the incidence of shock and MODS were studied among different types of the left ventricular structure and function in sepsis group.Results The levels of serum free tri-iodothyronine (FT3) and free tetra-iodothyronine (FT4) in sepsis group were significantly lower than those in control group (P ＜ 0.05),but there was no difference in level of thyroid stimulating hormone (TSH) between these two groups.The patients with sepsis had three types of the left ventricular dysfunction:diastolic dysfunction without the enlargement of left ventricular (type Ⅰ) in 31 patients,the enlargement of left ventricular with diastolic dysfunction (type Ⅱ) in 18 patients and the enlargement of left ventricular with both systolic and diastolic dysfunction (type Ⅲ) in 14 patients.Compared with the other two types,the type Ⅲ patients had significantly lower levels of FT3 and FT4 and higher incidences of shock and MODS (P ＜ 0.05).No significant difference in TSH level was found among the three types.There were no significantly differences in FT3 and FT4 between type Ⅰ and type Ⅱ,but the higher incidences of shock and MODS were found in type Ⅰ (P ＞ 0.05).Conclusions Most septic patients have thyroid function disorder.Serum thyroid hormone levels in early stage of sepsis have certain role in predicting changes in left ventricular structure and function in the late stage of disease.

Objective To investigate the effects of growth hormone on illness severity and prognosis of septic patients. Methods Thirty septic shock patients were randomized into control group (10 cases) and growth hormone treatment group (20 cases) , to receive 8 U recombinant human growth hormone every day for 7 consecutive days, control group received NS. Serum concentration of procalcitonin ( PCT) , C-reactive protein ( CRP) , tumor necrosis factor-? ( TNF-?) and interleukin-6 ( IL-6 ) were measured on the 1st,4th,and 7th day. The severity of illness was assessed daily with the Acute Physiology and Chronic Health Evaluation-Ⅱ (APACHE-Ⅱ ) scoring system and the Elebute & Stoner's Sepsis scoring system. The efficacy also were evaluated on day 15 postoperation. Results The serum concentration of PCT, CRP, TNF-?, IL-6 decreased gradurally in both group after study starting. PCT, TNF-? and IL-6 were significantly different on the 7th day in both group (P

Objective:To investigate the perfection and improvement of the execution of integrative medicine therapy in severe tetanus therapy, to successfully control tetanus severe spasms, autonomic dysfunction and prevent lethal side-effect of prolong and high-dosage sedative-muscle-relaxant therapy, resulted in significant reduction of mortality of tetanus.Methods:Symptoms, treatments and outcome of tetanus patients admitted to Peking University Third Hospital from 1965 to 2020 were reviewed. Patients were classified with Ablett classification. The cases of Ablett grade Ⅲ and Ⅳ were severe tetanus. The patients were divided into two groups according to whether they were treated together with traditional Chinese medicine (TCM) simultaneously during the standard tetanus treatment; the patients in the TCM group were divided into the tetanus TCM medication group and the non tetanus TCM medication group according to the medicine provided whether was in accord with the conventional tetanus TCM prescriptions. The mortality of each group was calculated. In addition, one survived and one deceased case with severe convulsion, autonomic nerve dysfunction (Ablett grade Ⅳ) were selected, combined with the treatment methods and curative effects, the types, use methods and outcomes of Chinese and Western medicine were analyzed.Results:The 46 tetanus cases were treated with Western medicine. Twenty-two of them, TCM were applied. Fifteen of the 22 cases took the TCM prescription which was accord with the conventional tetanus prescription. The mortality of the 46 cases was 21.7% (10/46). The number of non-TCM group was 24 cases, with mortality of 20.8% (5/24); 1 case was Ablett Ⅱ, 1 was Ablett Ⅲ and 3 were Ablett Ⅳ. The number of the TCM group was 22 cases, with mortality of 22.7% (5/22), 2 cases were Ablett Ⅲ, 3 were Ablett Ⅳ. The TCM prescription of these 5 deceased cases was not directed towards tetanus. The tetanus TCM medication group was 15 cases, with no mortality. Case analyses: case 1 was intubated because of severe spasms. Autonomic dysfunction occurred on the 8th day after admission. Esmolol with increasing the dosage of the sedatives and muscle relaxant, was not effective. Tetanus TCM was applied after 2 days of autonomic dysfunction happened. Autonomic dysfunction was then under controlled on the 2nd day post-TCM. She was recovery and discharged after 4 weeks. Case 2, also was intubated because of severe spasms. Autonomic dysfunction happened on the 3rd day after admission, and failed to be controlled by large-dose sedatives, muscle relaxant, and Esmolol. After 8 days of persistent autonomic dysfunction, tetanus TCM was applied and autonomic dysfunction was under controlled on the 2nd day post-TCM administration. Large dosage of muscle-relaxant was applied continuously. After 5 days' administration of TCM, the TCM was withdrew. One day after the withdrawal of TCM, respiratory and cardiac arrest happened because of the diffused bronchiole obstruction with pulmonary secretions loading.Conclusion:Based on the precise and real-time diagnosis of the state of the disease, integrative medicine therapy with an overall analysis tetanus TCM prescription, is the key of declining tetanus mortality.

Objective To explore the risk factors of the occurence and 28-day death of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU). Methods A prospective multicentral cohort study was conducted. The patients from five ICUs of grade A tertiary hospitals in Beijing from July 2009 to March 2014, including sepsis,septic shock,trauma,pneumonia,aspiration,massive blood transfusion,bacteremia and pulmonary contusion,were enrolled. Researchers in each center reported the records with uniform tables,which included demographic,systemic conditions,the primary disease,and the severity within 24 hours,past history and so on. According to the admission diagnosis in ICU,these patients were divided into ARDS group and other severe disease control group. The risk factors of occurence and prognosis of ARDS were analyzed by univariate analysis,multivariate logistic regression and multivariate COX regression analysis. Kaplan-Meier method was applied to draw the 28-day survival curves of the two groups. Results There were 343 critical patients included in this prospective multicenter cohort study,of which 163 patients who developed ARDS were considered as ARDS group(2 case lost to follow-up, and 49 died)and 180 patients who did not developed ARDS regarded as severe control group(1 case lost to follow-up, and 34 died). The 28-day mortality of ARDS group was significantly higher than that of severe control group〔30.43%(49/161)vs. 18.99%(34/179),χ2=6.013,P=0.014〕. Multivariate logistic analysis showed that aspiration〔odds ratio(OR)=6.390,95% confidence interval(95%CI)=2.046-19.953,P=0.001〕,history of alcohol (OR=4.854,95%CI=1.730-13.617,P=0.003),sepsis(OR=2.859,95%CI=1.507-5.425,P=0.001), pneumonia(OR=2.822,95%CI=1.640-4.855,P<0.001),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score(OR=1.050,95%CI=1.007-1.094,P=0.022)were significantly associated with increased risk of ARDS occurence. When respiratory rate>30 beats/min(OR=3.305,95%CI=1.910-5.721,P<0.001), heart rate>100 beats/min(OR=2.101,95%CI=1.048-4.213,P=0.037)happened in critically ill patients, it highly suggested ARDS would happen. The proportion of the patients whose serum creatinine>176.8 μmol/L in ARDS group was lower than that in control group(OR=0.387,95%CI=0.205-0.733,P=0.004). Multivariate COX regression analysis showed that old age and septic shock were significantly associated with the increased risk of in 28-day death of ARDS〔advanced age:hazard ratio(HR)=1.040,95%CI=1.018-1.064,P<0.001;septic shock:HR=3.209,95%CI=1.676-6.146,P<0.001〕. Kaplan-Meier showed that the survival patients in ARDS group was significantly lower than those in severe control group(χ2=7.032,P=0.008). Conclusions Among critical ill patients,aspiration,history of alcohol,sepsis,pneumonia,increased APACHEⅡ score were the risk factors of ARDS development. Respiratory rate>30 beats/min and heart rate>100 beats/min could predict the occurrence of ARDS in critical patients. Old age and septic shock were the risk factors of 28-day death of ARDS.

Objective:To systematically review and evaluate the predictive efficacy of various derived indicators of sequential organ failure assessment (SOFA) in mortality rate of sepsis patients.Methods:Literature on sepsis and SOFA scores were searched in PubMed, Embase and Cochrane Library. The retrieval time will be set to the time of database-building to February, 2023. The main outcome measures included 28-day mortality, 30-day mortality, in-hospital mortality, intensive care unit (ICU) mortality and long-term mortality. Literature screening, data extraction and quality evaluation were carried out independently by 2 researchers. Data were analyzed by Revman 5.3.5, Meta-disc and Stata software. Deek funnel plots were used to assess publication bias in the included studies.Results:A total of 40 articles including 51 trials were included. Of these, 32 were in English and 8 in Chinese, 17 were in prospective trials and 34 were in retrospective trials, 38 were in initial SOFA-related trials and 9 were in the change of SOFA score (ΔSOFA)-related studies, a total of 59?962 patients were enrolled. ① The area under the receiver operator characteristic curve (AUC) of initial SOFA and ΔSOFA for predicting outcome in sepsis was 0.773 and 0.787 ( Z = 0.115, P > 0.05), respectively. There was no significant difference between the two indexes in predicting the outcome of patients with sepsis. ② In subgroup analysis, due to limitations in the number of literature articles, the 28-day mortality rate and 30-day mortality rate were merged for discussion. The predictive power of ΔSOFA for 28-day or 30-day mortality was significantly higher than that of initial SOFA (AUC was 0.854, 0.787, Z = 2.603, P ≤ 0.01). ③ There were few studies onΔSOFA in predicting in-hospital mortality, ICU mortality and long-term mortality of sepsis patients. The AUC of the initial SOFA for predicting the study endpoints described above was: ICU mortality (0.814) > 28-day or 30-day mortality (0.787) > in-hospital mortality (0.697) > long-term mortality (0.646). ④ Initial SOFA and ΔSOFA in patients with sepsis of non-Han original had good predictive performance and there was no significant difference between them (AUC was 0.766, 0.811, respectively). However, the pooled sensitivity of ΔSOFA was higher (92%). ⑤ In prospective studies, initial SOFA was better at predicting outcomes in patients with sepsis (AUC was 0.804, pooled sensitivity 64%). The sensitivity of ΔSOFA indicators in predicting the outcome of sepsis patients was significantly higher than the initial SOFA (78% vs. 64%). The funnel plot showed that there was no significant publication bias in the included literature. Conclusion:ΔSOFA has a relatively high diagnostic efficacy in predicting short-term (28-day or 30-day) mortality in patients with sepsis.

Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.